HomeMy WebLinkAboutUtility Conn. 07-0720, Plmbg. 07-0967 oF PRI�� CITY OF P.RIOR�LAKE BUILDING PERMIT, Date Rec'd
,, , TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
�' � AND UTILITY CONNECTION PERMIT
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M�'�'NES��P I Whice File pERMIT N0.�.
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3 Yellow Apphcant
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ADDRESS i � ZONING (ott'ice use)
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LEGAL DESCRIPTION (office use only)
LOT � BLOCK ADDITION Z-c (�t�1 �5 t'��?' —br� PID Z.s— —Q -+Q
OWNER �� I � � ( L LG I 2�"�QI6 '��7�
(Name) � � (Phone) ��
(Address) C �
BUII.,DER
(Company m ) o
(Contact N m ( e
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Fimsh ❑ Fireplace
❑Addition ❑Alterat�on ❑Utility Connection
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CODE ❑i.R.c. ❑i.s.c. �M,s�. �ooK t> � f � S � ����
Type of Constn►ction: I II III N V A B
Occupancy Group: A B E F H I M R S U PROJECT COST/VALLTE $
Division: 1 2 3 4 5 (excluding land)
I hereby cernfy that 1 have fi�rnished mformauon on th�s apphcation which is to the best of my knowledge true and correct 1 also cert�fy that 1 am the owner or authorized agent for the
abuve-mennoned property and that all construct�on will confor to all exisung state and local laws and will proceed m accordance with submitted plans I am aware that the bmldmg
al ca evoke thu permit fo ust cause Furthermore, I here y agree that the c�ty official or a designee may enter upon the property to perform ne spccuons
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Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $ —
Permit Fee $ SAC # $ �'�G' � �
Plan Check Fee $ Water Meter Si e 5/8", 1"; $ 3 Z S, O �
State Surcharge $ Pressure Reducer $ ,�� �
Penalty $ Sewer/Water Connection Fee # $' SOQ , Oa
Plumbing Permit Fee $ Water Tower Fee # $ ��� Do
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ 3 S C Q Other $
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Gas Fireplace Permit Fee $ TOTAL DUE $ � � C.
This Ap a o Building Pernut pproved Paid O Recei t No. � Z.
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Buddm� �- ��al Date
Th�s �s to cert�fy that the request in the above apphcahon and accompanymg documents u m accordance wuh the Ciry Zoning Ordmance and may proceeA as requested. This ducument
when s�gned by the Gty Planner cunstitutcs a temporary Certtficate of Zonmg compliance and allows construcnon to commence. Before occupancy, a Ccruficare of Occupancy must be
ISSllfd
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
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CITY OF PRIOR LAKE
� D x SEWER AND WATER PERMIT _
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1 Green File pERMIT NO . o� O�� D
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3 Gold Applicant
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ADDRESS � ZONING (oflfice use)
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LEGAL DESCRIPTION (oR'ice use only)
LOT 4 BLOCK `ADDITION fiV�GeOS k's/ O�� /V4/�.�� PID �` �^�L(o. !10¢ v
OWNER
(Name) ��� ��'��C'�. (Phone) �o �Z . ( a �!o . �(07 <v
(Address)
(Address) (City) (Zip Code)
APPLICANT
(Name) /'��f1OSf� f� ��C C/9 V�4 �7�1/U('-7 (Phone) `��. `
(Address) / 9C� 3 C� �Xf?S /g !�f NV F.� /� L . �Si3 � Z
(Address) , (City) (Zip Co )
(Contact Person) /Vd r�'� (Phone)
APPLICANT SIGNATURE DATE � �' � �
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure feet.
Type of sewer pipe. ❑ ABC � PVC � Cast Iron
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
FEE SCHEDULE
Residential sewer and water line connection $35.50 Industrial, Com'1 & Multi-family 1% of job cost with a$39.50 minimum
Sewer connection only $17.50 Water connection only $17.50
Estimated Cost $ Building Permit #
SEWER AND WATER PERMIT FEE $
STATE SURCHARGE $ � �� �
TOTAL PERMIT FEE $ BUILDING RERMlT
(Oftice Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Building Official Date
24 hour notice for ail inspections (952) 447-9850, fax (952) 447-4245
O F YR J�,� Date Rec'd
� D� CITY OF PRIOR LAKE PLUMBING PERMIT � �, g d �
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' B '"` F "° pERMIT NO.
s com c�ry 7
3 Yellow Applicant O / � � �
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ADDRESS ZONII�TG (otTice use)
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LEGAL DESCRIPTION (of&ce use onty)
LOT BLOCK ADDITION PID ZS �f{� U"O�.O
OWNER
(Name) (Phone)
(Address)
APPLICANT ' � I V....,. I� ,.. � S�L y 4/ � l/ Z�
(Name) � � � � � � � 7 (Phone) � � �
(Address)
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(Address) (City) (Zip Code)
(Contact Person) � �� � a ��MctyO�, (Phone) �� Z • — g � (° " `� 7 �" a
APPLICANT SIGNATURE �''� ---� DATE � � � a
4r�. � � M oo ��3
APPLICANT PLEASE COMPLETE BELOW
Quaatity Type of Fixtare Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial 8c Multi-family 1% of job cost with a$39.50 minimum Residential, New One & Two-Family 599.50
Residential, Additions & A[terations �39.50
Estimated Cost $ Building Permit #
PLUMBING PERMIT FEE $ 3 �� ��
STATE SURCHARGE $ .50
_ TOTAL PERMIT FEE $ ¢D. Gv
(Office Use O y)
This A ' a i Becomes uilding Perm' W en Approved Paid �� G � Re �pt No�
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�O O Date 8 � B
uild' O�cia! ate « � '
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714